Case Study Analysis on Risk Factors, Symptoms, Diagnosis and Treatment of Haemophilus Meningitis

This case study analysis discusses the risk factors, symptoms, diagnosis and treatment of Haemophilus Meningitis. It provides insights into the pathophysiology of the disease and the treatment modalities used to combat it. The study also highlights the importance of vaccination in preventing the onset of bacterial meningitis.

Running head: NURSING ASSIGNMENT
Case Study analysis
Name of the Student
Name of the University
Author Note

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1. Risk factors and etiology- Meningitis refers to the acute inflammation of the meninges
that are known to function as protective membranes, which cover the brain and the spinal
cord. The most common symptoms of this disease are headache, fever, neck stiffness and
an altered sense of consciousness. The most serious form of meningitis occurs due to
bactieria and can lead to seizures, stroke, sepsis, or even death (Marais et al., 2014). In
the case study the patient Ethan was diagnosed with Haemophilus meningitis that is
caused due to the bacteria Haemophilus influenzae. This meningitis can be deadly. There
are a range of risk factors that increase the likelihood of a person to suffer from the
condition. The bacteria spread through the air, upon sneezing or coughing. Moreover,
risks of developing bacterial meningitis also increase due to lack of adequate vaccination.
Similarly, children under two years of age are more prone to contracting the disease
(Wall et al., 2014). It can be deciphered from the case scenario that Ethan had not been
vaccinated previously. Thus, his age and vaccination history are the risk factors that
might have contributed to onset of bacterial meningitis (Fernandes, Gonçalves-Pereira,
Janeiro, Silvestre, Bento & Póvoa, 2014). Before the introduction of Haemophilus
influenzae type b vaccine, the pathogen was considered responsible for 75% of bacterial
meningitis cases, followed by Streptococcus infection (McCormick et al., 2013). The fact
that the rates of the disease are higher at regions with limited vaccination levels can be
accounted as a major reason that contributed to the disease (Okike et al., 2014). This
made the bacteria reach the CNS, followed by inducing production of inflammatory
mediators that enhanced leukocyte influx in the CSF and manifested in the form common
symptoms.

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2. Signs and symptoms- Haemophilus species belong to a group of facultative anaerobic
coccobacilli or oxidase-positive pleomorphic gram-negative bacteria. Choroid plexus has
been identified as the most common site of bacterial invasion that leads to bacteria, which
in turn precedes meningitis. The sites of entry are common vascularised regions. The
pathogens are known to carry effective molecular mechanism that assists them to cross
the blood brain barrier and overcome the tight junctions (Heckenberg, Brouwer & van de
Beek, 2014). Thus, these bacteria that lead to the development of meningitis in children
are found to be well equipped with several adhesive proteins that help in the invasion of
CNS. Endothelial cell invasion is a prerequisite for the invasion of bacteria and leads to
deregulation of major adhesion molecules (Barichello, Fagundes, Generoso, Elias,
Simões & Teixeira, 2013). Furthermore, leukocytes act as diagnostic hallmarks of the
condition. In addition to endothelial cells, mast cells and perivascular macrophages also
bring about inflammation of the meninges. This leads to neuronal loss from the
hippocampus that translates in the form of hippocampal atrophy (Barichello, Generoso,
Milioli, Elias & Teixeira, 2013). Clinical symptoms that were presented by the patient
Ethan include high fever, resistance to passive neck flexion, high blood pressure and
previous history of seizures. The diagnostic signs classic triad often consists of sudden
elevation in body temperature, and neck stiffness. Inflammation in the brain tissue most
often results in an increase in pressure in the regions that lead to seizures. Furthermore,
running fever can be accounted as defensive reaction of the immune system against
bacterial infections. In addition, stiffness in the neck, involves a reduction in the ability to
flex the neck in a forward direction (Nakao, Jafri, Shah & Newman, 2014). Thus, his
signs and symptoms are related to the underlying pathophysiology.

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3. Diagnosis and treatment modalities- The major diagnostic test in order to confirm
meningitis is a blood test that acts as major markers that indicate inflammation. Blood
will be drawn to check for the count of red and white blood cells. Blood cultures will be
taken in a culture dish for checking for the presence of Haemophilus bacteria. With the
aim of conducting a definitive diagnosis for meningitis in Ethan, a lumbar puncture will
be performed. A spinal tap will be needed for collecting cerebrospinal fluid (CSF), which
will indicate presence of low sugar levels, with an increased count of proteins and white
blood cells (Glimåker, Johansson, Grindborg, Bottai, Lindquist & Sjölin, 2015). Blood
electrolytes will also be measured to identify presence of hyponatremia or low sodium
count in the blood. The primary goal of the treatment modalities will be maintenance of
the cerebral perfusion pressure. This will be achieved by preserving mean arterial
pressure and normalizing the intracranial pressure. Antibiotic therapy will be considered
as the mainstay of treatment for the symptoms presented by Ethan. The choice of
antibiotics will depend on the bacteria that have been isolated. Common antibiotics that
will be used include cefotaxime or ceftriaxone (Van de Beek et al., 2016). These
antibiotics will be able to combat the Haemophilus infection and will reduce
inflammation of the meninges. Furthermore, corticosteroids will also be given for
reducing inflammation of the brain (Brouwer, McIntyre, Prasad & van de Beek, 2013).

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References
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(2013). Pathophysiology of neonatal acute bacterial meningitis. Journal of medical
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Barichello, T., Generoso, J. S., Milioli, G., Elias, S. G., & Teixeira, A. L. (2013).
Pathophysiology of bacterial infection of the central nervous system and its putative role
in the pathogenesis of behavioral changes. Revista brasileira de psiquiatria, 35(1), 81-87.
http://dx.doi.org/10.1016/j.rbp.2012.11.003
Brouwer, M. C., McIntyre, P., Prasad, K., & van de Beek, D. (2013). Corticosteroids for acute
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49.DOI: 10.1002/14651858.CD004405.pub4
Fernandes, D., Gonçalves-Pereira, J., Janeiro, S., Silvestre, J., Bento, L., & Póvoa, P. (2014).
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Glimåker, M., Johansson, B., Grindborg, Ö., Bottai, M., Lindquist, L., & Sjölin, J. (2015). Adult
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Heckenberg, S. G., Brouwer, M. C., & van de Beek, D. (2014). Bacterial meningitis.
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